AG Keith Ellison’s office calls Mayo Clinic’s apparent bill-collection conduct 'aggressive'

Attorney General Keith Ellison’s office is looking into Mayo Clinic following a Post Bulletin investigation about the hospital suing low-income patients for unpaid medical bills.

Minnesota Attorney General Keith Ellison
Minnesota Attorney General Keith Ellison's office said that they want to hear from any Minnesotan who is struggling with hospital bills. “This is very important to us,” spokesperson John Stiles said.
Joe Ahlquist / Post Bulletin

ROCHESTER, Minn. — Attorney General Keith Ellison’s office is looking into Mayo Clinic’s billing and collection practices following a Post Bulletin investigation about the hospital suing low-income patients for unpaid medical bills.

"Mayo's apparent aggressive bill-collection conduct that the Post-Bulletin reported is alarming,” said John Stiles, spokesperson for the AG's office. “We take that very seriously and have asked Mayo for more information."

Mayo Clinic responded in an email.

"We are responding to the Attorney General’s request and welcome the opportunity to provide an accurate and complete picture of our billing and collection practices," said Ginger Plumbo, Mayo Clinic spokesperson. "We are confident that our response will demonstrate that financial assistance is an important part of Mayo Clinic’s relationship with patients and is shared with them at points before, during and after care is provided."

The Post Bulletin interviewed 20 patients sued by Mayo Clinic for unpaid bills and determined that 14 could have qualified for discounted or free care, also known as charity care, based on the household income information provided during the interview. Yet all but one were forced to pay their bills in full after they were sued, often through wage garnishment. Most had no idea charity care was an option.


Nonprofit hospitals must offer free or discounted care to eligible patients. But the Post Bulletin discovered that some patients sued by Mayo for unpaid medical bills didn't know this option existed.

Mayo Clinic meets the IRS’s requirement that nonprofit hospitals “widely publicize” their charity care policies. In an email, Mayo said that it promotes its financial assistance programs on its website, authorization forms, hospital and emergency room signage and monthly statements and letters.

Yet 12 of the 14 income-eligible patients interviewed said Mayo made no mention of charity care when they called for help with an unaffordable bill, instead suggesting payment plans or assistance outside of Mayo. The two who discussed charity care with clinic billing employees said they were informed about the policy only when they explicitly asked about it.

Stiles said that he and his team are thinking about ways their office can better highlight the existence of charity care, and that, based solely on the Post Bulletin’s reporting, he thinks Mayo Clinic may be in violation of the “letter and spirit of the Hospital Agreement.”

The Hospital Agreement is a voluntary agreement between the Minnesota attorney general and all but one of Minnesota's hospitals that sets standards for hospitals' billing and collection practices and provides patients and consumers with a variety of protections and assurances.

It was first negotiated in 2005 and has been renegotiated every five years beginning in 2007, with the most recent agreement reached in 2022 .

Every nonprofit hospital, including Mayo, is required to provide free or discounted care, also known as "charity care," to maintain its nonprofit status with the IRS and reap the benefits of tax exemption. Experts say that financially strong nonprofit hospitals need to be doing more to make it a fair exchange.

In 2020, the Attorney General's Office used the Hospital Agreement and the office's general consumer-protection authority under state law to reach a settlement with Hutchinson Hospital, which the office alleged had improperly increased patients’ payment plans, deactivated the payment plans of patients who did not agree to the new terms, and pressured patients to secure loans or use their retirement savings to satisfy their medical debts.

The settlement required the hospital to restore more favorable hospital billing terms that it had unilaterally terminated for many of its patients. As a result of the settlement, Stiles said his office estimated in July 2021 that Hutchinson Hospital patients had saved upward of $184,000 .

Stiles said there are many ways that Minnesotans can advocate for themselves when faced with an unaffordable bill.


  1. Contact the Attorney General's Office immediately by phone at 651-296-3353 or 800-657-3878, by filling out a complaint online or by emailing 
  2. Specifically ask the provider for charity care.
  3. Ask for a reasonable payment plan.
  4. Review the attorney general's publication on medical billing.
  5. Get familiar with the Hospital Agreement so you know your rights.

“We really do want to hear from any Minnesotan, whether in the Rochester area or beyond, who is struggling with hospital bills,” Stiles said. “This is very important to us.”

Many patients haven’t heard of "charity care," also known as financial assistance, although every nonprofit hospital, including Mayo Clinic, is required to provide it. And even when patients discover it, many struggle because the application process is too burdensome or they avoid it altogether, reluctant or hesitant to apply for “charity.”

Molly Castle Work is an award-winning investigative journalist. She has investigated a range of topics such as OSHA and worker safety during COVID-19, racially-disproportionate juries and white-owned newspapers' role in promoting lynchings. Readers can reach Molly at 507-285-7771 or
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